As I cast my mind back over the past weeks and try to remember some of the anatomy I fought long and hard to learn, I come up blank in a lot of areas. I can, of course, remember the major things, big muscles etc.., but I can't recall necessarily the spinal segment of a given nerve, or the course of the lesser occipital nerve, or which muscles articulate the thumb. Even metabolism is fading, and it's only been a week since my last exam. I don't recall all the details of gluneogenesis regulation for example. Medical school is a process of cramming, literally. Recall those days in school right before a final exam when you were trying desperately to remember some fact only for the exam. That's how I study, only all the time. I don't know how long term retention is possible, given the pace and quantity of information to learn. I think the theory is that I will now have a context of information that I will reinforce during the last two years of school and eventually in residency. It's a sound idea in principle, and the quantity of information makes this system necessary, but it is quite frustrating to study 50-70 hours a week and not remember the things that took so much effort to learn.
The metabolism unit here is in dire need of reworking. The previous course director left and is in Atlanta now, but he would have been gone anyway because the students collectively upbraided him year after year in course evals. The resulting course that I have endured, is a hodgepodge of biochem and nutrition with some esoteric diseases thrown in for interest. I currently don't really think I could give decent nutritional advice to a patient based on information I learned here that I didn't already know from the Cheerio's box. That's not saying I haven't learned, but the things I have learned don't seem to be really applicable. Yes, I might understand the mechanism of non-classical galactosemia, but I can't explain in layman's (or Laman's as Aaron would say) terms how diabetes works, or the regulation of protein v. fat v. sugar usage in the body, or how satiety and appetite are currently understood, or the role of exercise on the whole system at a biochemical level. Some of this will hopefully be elucidated in the subsequent 4 weeks, but I'm not too sanguine. Perhaps, again, the current classes are laying a foundation for the GI unit next year and the wards in later years. If so, patience is in order, but the current unit is still a disjointed conglomeration of lectures loosely based on metabolism.